Rural-urban residence and life expectancies with and without pain.

This paper analyzes rural-urban disparities in life expectancy with and without pain among upper-middle age and older adults. Data are from the nationally representative Health and Retirement Study, 2000-2018, N = 18,160, age 53+. Interpolated Markov Chain software, based on the multistate life tables, is used to calculate absolute and relative pain expectancies by age, sex, rural-suburban-urban residence and U.S. regions. Results show significant rural disadvantages versus those in urban and often suburban areas. Example: males at 55 in rural areas can expect to live 15.1 years, or 65.2 percent pain-free life, while those in suburban areas expect to live 1.7 more years, or 2.6 percentage points more, pain-free life and urban residents expect to live 2.4 more year, or 4.7 percentage points more. The rural disadvantage persists for females, with differences being a little less prominent. At very old age (85+), rural-urban differences diminish or reverse. Rural-urban pain disparities are most pronounced in the Northeast and South regions, and least in the Midwest and West. The findings highlight that rural-urban is an important dimension shaping the geography of pain. More research is needed to disentangle the mechanisms through which residential environments impact people's pain experiences.

Are We Adding Pain-Free Years to Life? A Test of Compression Versus Expansion of Morbidity.

BACKGROUND: There has been debate regarding whether increases in longevity result in longer and healthier lives or more disease and suffering. To address the issue, this paper uses health expectancy methods and tests an expansion versus compression of morbidity with respect to pain. METHODS: Data are from 1993 to 2018 Health and Retirement Study. Pain is categorized as no pain, non-limiting and limiting pain. Multistate life tables examine 77,996 wave-to-wave transitions across pain states or death using the Stochastic Population Analysis for Complex Events program. Results are presented as expected absolute and relative years of life for 70-, 80- and 90-year-old males and females. Confidence intervals assess significance of differences over time. Population- and status-based results are presented. RESULTS: For those 70 and 80 years old, relative and absolute life with non-limiting and limiting pain increased substantially for males and females, and despite variability on a wave-to-wave basis, results generally confirm an expanding pain morbidity trend. Results do not vary by baseline status, indicating those already in pain are just as likely to experience expansion of morbidity as those pain-free at baseline. Results are different for 90-year-olds who have not experienced expanding pain morbidity and do not show an increase in life expectancy. CONCLUSIONS: Findings are consistent with extant literature indicating increasing pain prevalence among older Americans and portend a need for attention on pain-coping resources, therapies, and prevention strategies.

Multimorbid life expectancy across race, socio-economic status, and sex in South Africa.

Multimorbidity is increasing globally as populations age. However, it is unclear how long individuals live with multimorbidity and how it varies by social and economic factors. We investigate this in South Africa, whose apartheid history further complicates race, socio-economic, and sex inequalities. We introduce the term 'multimorbid life expectancy' (MMLE) to describe the years lived with multimorbidity. Using data from the South African National Income Dynamics Study (2008-17) and incidence-based multistate Markov modelling, we find that females experience higher MMLE than males (17.3 vs 9.8 years), and this disparity is consistent across all race and education groups. MMLE is highest among Asian/Indian people and the post-secondary educated relative to other groups and lowest among African people. These findings suggest there are associations between structural inequalities and MMLE, highlighting the need for health-system and educational policies to be implemented in a way proportional to each group's level of need.

Estimating Health Expectancy in Japanese Communities Using Mortality Rate and Disability Prevalence.

Introduction: Although mortality and disability are known to be associated with health expectancy (LE), few studies have assessed the extent to which a reduction in their prevalence can extend a person's LE. Moreover, differences in this relationship based on gender have not been established. Thus, in this study, we constructed a regression model using the rate of mortality and prevalence of disability to predict LE in older adults (≥65 years) and assess the relationships between LE, mortality rate, and disability prevalence based on gender. Methods: Data were collected from Japan's population registry and long-term insurance records (N = 344). Multiple linear regression was used to analyze the relationship between LE, mortality rate, and disability prevalence, stratified by gender. Results: Age-adjusted mortality rate and disability prevalence significantly predicted LE and were significantly correlated with the measured LE index for both genders. For every 1% annual decrease in age-adjusted mortality, LE increased by 1.54 years for men and 2.15 years for women. Similarly, a 1% annual decrease in age-adjusted disability prevalence increased LE by 0.22 years for men and 0.32 years for women. The regression model coefficients indicated that the strength of the association between LE, mortality rate, and disability prevalence differed between genders. Our model accurately predicted LE (men: adjusted R2 = 0.968, women: adjusted R2 = 0.994). Conclusions: Health promotion policies that are geared toward increasing health expectancy can be evaluated using mortality rate and disability prevalence as prognostic indicators. The strength of the association between LE, mortality, and disability differed between genders, suggesting the need for gender-specific policy planning to increase LE for both genders.

National and education-specific trends in life and health expectancies in Denmark 2004-2015.

BACKGROUND: Several studies have revealed widening of inequalities in life expectancy, but little is known about the recent changes in health expectancy nationally and between socioeconomic groups. This study examines dynamics of national and education-specific life expectancy and health expectancies at age 50 years in Denmark from 2004/2007 to 2015. METHODS: Nationwide register data on education and mortality were linked and combined with Danish health data from the Survey of Health, Ageing and Retirement in Europe and changes in life expectancy and three health expectancy indicators were estimated by Sullivan's method. RESULTS: From 2004 to 2015, national life expectancy at age 50 years increased by 2.4 years for men and 2.1 years for women. Simultaneously, after an initial rapid improvement from 2004 to 2007, the pace of progress in health expectancy decreased. From 2007 to 2015, the difference in life expectancy at age 50 years between men with long and short education increased from 4.3 to 5.0 years. For women, the corresponding increase in the life expectancy gap was less pronounced from 3.5 to 3.8 years. The educational gap in lifetime without long-term illness decreased from 4.6 years to 3.1 years for men and from 6.1 years to 4.6 years for women. On the contrary, the educational gap increased for lifetime without activity limitations and in self-rated good health. CONCLUSIONS: Previously observed improvements in health expectancy in Denmark slowed down despite continuing progress in life expectancy. This worrying change coincides with persistent educational inequalities in life expectancy and health expectancy and is a challenge to a sustainable social and health development in the future.

Appropriate Categorization of Inequality to Inform Policy Decisions: Estimating Distribution of Lifetime Health Using Alternative Approaches to Socioeconomic Stratification.

OBJECTIVES: Estimation of gradients in lifetime health, notably quality-adjusted life expectancy (QALE), has largely focused on index of multiple deprivation to categorize the population by socioeconomic position. In this article, we estimate QALE using alternate, individual- rather than area-level, indicators of socioeconomic position. METHODS: Building on previous research methods, the distribution of QALE is estimated across education and income groups based on data from the Health Survey for England and the Office for National Statistics. QALE is estimated for each group by combining multivariate mortality rates and health-related quality of life (HRQL) weights using life tables. HRQL weights were estimated using ordinary least squares and missing data were handled using multiple imputation. RESULTS: The estimated lifetime HRQL weights decreased with increased age, lower educational attainment, and lower income. For example, the QALE at birth for males in the lowest educational attainment group was 61.69 quality-adjusted life-years (QALYs), 1.54 QALYs lower than females in the same group. This is in contrast to 76.58 and 75.89 QALYs for males and females in the highest educational attainment group, respectively. A similar trend was observed across income quintiles albeit the gap was less pronounced. CONCLUSIONS: The use of index of multiple deprivation to assess health inequalities may be masking important information about individual-level variation. Decisions makers should consider this alongside the merits of using area-level approaches to categorizing the population if individual-level approaches are preferable.

Disability and morbidity among US birth cohorts, 1998-2018: A multidimensional test of dynamic equilibrium theory.

A substantial body of prior research has explored patterns of disability-free and morbidity-free life expectancy among older populations. However, these distinct facets of later-life health are almost always studied in isolation, even though they are very likely to be related. Using data from the US Health and Retirement Study and a multistate life table approach, this paper explores the interactions between disability, morbidity, and mortality by sex and education among four successive US birth cohorts, born from 1914 to 1923 to 1944-1953 and compared in the periods 1998-2008 and 2008-2018. We find little compression of disability but a marked expansion of morbidity across cohorts. However, disability-free life expectancy (DFLE) among those living with chronic morbidities has increased, even though at the population-level DFLE is largely unchanged. Broadly, these patterns suggest that successive cohorts of older populations in the US are experiencing a dynamic equilibrium, where the link between chronic morbidities and disability has weakened over successive cohorts. Investigating patterns by educational attainment, we find marked disparities where the least educated individuals not only live significantly fewer years free of disabilities or chronic morbidities but also have experienced an expansion in morbidity and disability. Our findings suggest that the future trajectory of disability-free life expectancy in the US is increasingly contingent on efforts to improve disease management and control the severe consequences of chronic morbidities.

Impact of adverse childhood experiences on life expectancy with depression in the U.K. population: The mitigating role of educational attainment.

BACKGROUND: Adverse childhood experiences (ACEs) are associated with depression in later life. OBJECTIVE: This study aimed to measure the impact of ACEs on life expectancy with depression (DLE) and to assess how educational attainment affected expectations. PARTICIPANTS AND SETTING: The study used data on 5597 participants from the English Longitudinal Study of Aging (2006-2013). METHODS: Depression was assessed through the eight-item short version of the Centre for Epidemiologic Studies Depression. We used discrete-multistate life table models to estimate total life expectancy and life expectancy with depression. RESULTS: Older adults with ACEs had longer DLE and a higher proportion of remaining life with depression compared with those without ACEs. For example, men aged 60 years with ACEs could expect to live 5.2 (95 % confidence interval (CI): 4.2, 6.2) years with depression compared with 2.8 (95 % CI: 2.3, 3.3) years for men without ACEs. Women aged 60 years who reported ACEs could expect to live 9.4 (95 % CI: 7.6, 11.1) years with depression compared with 6.0 (95 % CI: 5.1, 7.0) years for women without ACEs. With a high level of educational attainment, older adults from younger cohorts with ACEs lived fewer depression years and spent a higher proportion of their life being free of depression than adults with ACEs and had a low level of educational attainment. CONCLUSION: Our results indicated that ACEs may increase years of life with depression among U.K. adults. Meanwhile, high educational attainment could mitigate the mental health burden associated with ACEs.

The effects of loneliness and social isolation on cognitive impairment-free life expectancy in older adults.

OBJECTIVES: This article aimed to examine the effects of social connection comprising loneliness and social isolation on cognitive impairment-free life expectancy (CIFLE). METHODS: Data on 28,563 older adults (aged 65+) were drawn from the Chinese Longitudinal Healthy Longevity Survey with a median follow-up of 4.00 years. Multistate Markov models were used to estimate the independent and joint effects of social connection with CIFLE. Cognitive impairment was measured by the modified Mini-Mental State Examination. RESULTS: For men and women, respectively, reduced CIFLEs at age 65 associated with loneliness were 0.95 (95% CI: 0.41-1.48) and 1.35 (95%: CI 0.77-1.90) years, and those associated with social isolation were 2.23 (95% CI: 1.67-2.78) and 2.49 (95% CI: 1.67-3.30) years. Compared with those with neither loneliness nor social isolation ('neither' group), older adults at age 65 with both loneliness and social isolation ('both group') lost CIFLEs of 2.68 (95% CI: 1.89-3.48) and 3.51 (95% CI, 2.55-4.47) years for men and women, respectively. Similar patterns were observed in the oldest-old adults (age 85 or over). A growth trend transpired in the difference of the proportion of the remaining CIFLE between 'neither' group and 'both' group with age. CONCLUSION: Loneliness and social isolation are associated with decreased CIFLE in older Chinese adults. Policy makers and the public must be informed that early identification and management of loneliness and social isolation, especially when coexisting, are crucial.

Subjective Well-Being and Active Life Expectancy in Japan: Evidence From a Longitudinal Study.

Background and Objectives: Existing research has suggested that older adults in Japan enjoy phenomenal physical health status, but they have poor subjective well-being (SWB). Limited empirical evidence exists, however, on how physical health and SWB intersect and are linked to the lives of older men and women in Japan. Using the concept of health expectancy, this study examines the role of SWB, as measured by life satisfaction, in the mortality and morbidity experiences of Japanese adults aged 65 years and older. Research Design and Methods: We used the nationally representative Nihon University Japanese Longitudinal Study of Aging, 1999-2009. Our measurement of morbidity is disability, based on difficulty in activities in daily living (ADLs) and instrumental ADLs. We use the Interpolation of Markov Chains approach to compute life expectancy (LE), LE without disability (active LE), and LE with differing severity of disability for those who are satisfied with life and for those who are not. Results: We documented significant differences in LE and active LE by the state of life satisfaction among older adults in Japan. Men and women who are satisfied with life are expected to live longer and spend more years without having disability compared to those who are not satisfied. We found no differences in the length of life with disability of differing severity by the state of life satisfaction. Discussion and Implications: Our results highlight the important role of SWB at older ages in Japan, because it is directly related to the physical health of its aging population. Fully understanding the health of the older population requires research that focuses on both objective and subjective dimensions of well-being.

Educational Differences in Life Expectancies With and Without Pain.

OBJECTIVES: This study computes years and proportion of life that older adults living in the United States can expect to live pain-free and in different pain states, by age, sex, and level of education. The analysis addresses challenges related to dynamics and mortality selection when studying associations between education and pain in older populations. METHODS: Data are from National Health and Aging Trends Study, 2011-2020. The sample contains 10,180 respondents who are age 65 and older. Pain expectancy estimates are computed using the Interpolated Markov Chain software that applies probability transitions to multistate life tables. RESULTS: Those with higher educational levels expect not only a longer life but also a higher proportion of life without pain. For example, a 65-year-old female with less than high school education expects 18.1 years in total and 5.8 years, or 32% of life, without pain compared with 23.7 years in total with 10.7 years, or 45% of life without pain if she completed college. The education gradient in pain expectancies is more salient for females than males and narrows at the oldest ages. There is no educational disparity in the percent of life with nonlimiting pain. DISCUSSION: Education promotes longer life and more pain-free years, but the specific degree of improvement by education varies across demographic groups. More research is needed to explain associations between education and more and less severe and limiting aspects of pain.

Changes in quality-adjusted life expectancy in Belgium, 2013 and 2018.

INTRODUCTION: No information is available in Belgium on life expectancy adjusted for health-related quality of life (HRQoL). Quality-adjusted life expectancy (QALE) captures the multidimensionality of health by accounting for losses in mortality and HRQoL linked to physical, mental, and social impairments. The objective of this study is to estimate for Belgium QALE, the changes in QALE between 2013 and 2018 and the contribution of mortality, HRQoL and its dimensions to this trend. METHODS: The Belgian Health Interview Survey (BHIS), a representative sample of the general population, included the EQ-5D-5L instrument in 2013 and 2018. The tool assesses HRQoL comprising five dimensions (mobility, self-care, usual activities, pain/discomfort, anxiety/depression) using a 5-level severity scoring to define a large variety of health states. The Sullivan method was used to compute at different ages QALE by gender using mortality data from the Belgian statistical office and average EQ-5D scores from the BHIS. QALE was calculated for 2013 and 2018, and changes in QALE over time were decomposed into mortality and ill-health effect. RESULTS: In 2018, QALE at age 15 years (QALE15) was 56.3 years for women and 55.8 years for men, a decrease from 2013 by 0.7 year for women and a stagnation for men. In men, the decrease in mortality counterbalanced the decline in HRQoL. The decline in QALE in women is driven by a decrease in mortality rates that is too small to compensate for the substantial decline in HRQoL before the age of 50 years. In women at older ages, improvements in HRQoL are observed. In women, QALE15 is decreasing due to an increase in pain/discomfort, anxiety/depression and problems in usual activities. In men at age 15, the pain/discomfort and anxiety/depression domains contributed to the stagnation. QALE65 increased somewhat, due to an improvement in self-care and mobility for both genders, and usual activities and anxiety/depression in men only. CONCLUSION: The strength of QALE as member of the family of composite indicators, the health expectancies, is the multidimensional structure of the underlying health component, including both ill-health with different health domains as levels of severity. The ability to decompose differences in the health expectancy not only into a mortality and health component but also into the different health dimensions allows to better inform on general population health trends. Next, compared to other health expectancy indicators, QALE is more sensitive to changes at younger ages.

Well-Being Adjusted Health Expectancy: A New Summary Measure of Population Health.

We propose a new summary measure of population health (SMPH), the well-being-adjusted health expectancy (WAHE). WAHE belongs to a subgroup of health-adjusted life expectancy indicators and gives the number of life years equivalent to full health. WAHE combines health and mortality information into a single indicator with weights that quantify the reduction in well-being associated with decreased health. WAHE's advantage over other SMPHs lies in its ability to differentiate between the consequences of health limitations at various levels of severity and its transparent, simple valuation function. Following the guidelines of a Committee on Summary Measures of Population Health, we discuss WAHE's validity, universality, feasibility sensitivity and ensure its reproducibility. We evaluate WAHE's performance compared to life expectancy, the most commonly used indicators of health expectancy (HE) and disability-adjusted life expectancy (DALE) in an empirical application for 29 European countries. Data on health and well-being are taken from the 2018 EU-SILC, and the life tables are from Eurostat. DALE is taken from the database of the Global Burden of Disease Programme. WAHE's sensitivity to univariate and multivariate state specifications is studied using the three Minimum European Health Module health dimensions: chronic morbidity, limitations in activities of daily living, and self-rated health. The empirical tests of the indicators' correspondence reveal that WAHE has the strongest correlation with the other SMPHs. Moreover, WAHE estimates are in agreement with all other SMPHs. Additionally, WAHE and all other SMPHs form a group of reliable indicators for studying population health in European countries. Finally, WAHE estimates are robust, regardless of whether health is defined across one or multiple simultaneous dimensions of health. We conclude that WAHE is a useful and reliable indicator of population health and performs at least as well as other commonly used SMPHs. Supplementary Information: The online version contains supplementary material available at 10.1007/s10680-022-09628-1.

Health-Related Expectations Regarding Aging among Middle-Aged and Older Japanese: Psychometric Performance and Novel Findings from the ERA-12-J.

BACKGROUND AND OBJECTIVES: Health-related expectations regarding aging is a gerontological construct that is potentially predictive of morbidity and mortality in later life. The Expectations Regarding Ageing scale (ERA-12) is a widely used measure of health-related expectations, although it has not previously been administered in Japanese. The present research aimed to elucidate the psychometric properties of the first Japanese translation of the ERA-12 and evaluate health-related expectations among middle-aged and older Japanese. RESEARCH DESIGN AND METHODS: Repeated online surveys were conducted with representative quota samples of middle-aged and older adults in Tokyo during 2021 (N = 1600). Primary outcome measures included total and subscale scores on a Japanese translation of the ERA-12 (ERA-12-J) addressing perceptions of physical, mental, and cognitive health. Standard measures were also used to gather information regarding respondent demographic details, general health, and health-related behavior. RESULTS: The ERA-12-J and associated subscales showed acceptable test-retest reliability (t(1598) = 0.60, p = 0.63), internal consistency (α > 0.80), inter-item correlation (r = 0.21-0.78) and item-total correlation (r = 0.53-0.73). Confirmatory Factor Analysis verified the hypothesized three-factor structure and construct validity on four common indices of fit (GFI = 0.968; CFI = 0.978; AGFI = 0.950; RMSEA = 0.059). ERA-12-J scores among Japanese respondents revealed prevailing negative sentiments concerning physical and cognitive health, with less negative sentiment regarding mental health. Significant and independent differences emerged concerning gender and age cohort, with middle-aged adults and females holding more negative expectations about their future health. DISCUSSION AND IMPLICATIONS: The ERA-12-J provides a sound basis for the elucidation of health-related expectations about aging in Japan and a useful tool for international comparative studies. Education and workplace intervention may be required in Japan to address age and gender disparities in health-related expectations.

Trends in healthy life expectancy in the age of austerity.

BACKGROUND: Worrying changes in life expectancy trends have been observed recently in the UK, largely attributed to austerity policies introduced over the last decade. To incorporate changes to quality, rather than just length of, life, our aim was to describe trends in healthy life expectancy (HLE) for the relevant period. METHODS: In the absence of available long-term trends, we calculated new estimates of HLE for Scotland for the period 1995-2019, using standard HLE methodologies based on mortality and national survey data, and stratified by sex and socioeconomic deprivation. RESULTS: Overall, male and female HLE increased markedly between 1995 and 2009, but then decreased by approximately 2 years between 2011 and 2019. A decline was observed for the most and least deprived groups, but this was larger for those living in the 20% most deprived areas, where the decrease was 3.5 years. CONCLUSIONS: Our findings are further evidence of changing levels of pre-pandemic population health in the UK. An increasing body of UK and international evidence have attributed these changes to UK Government austerity policies. There is an urgent need, therefore, to reverse cuts to social security and protect the income and health of the poorest across all of the UK.

Changes in Health Expectancy for Older Adults in Japan: Results from Two Longitudinal Surveys.

BACKGROUND: Although there is evidence of improvements in health expectancy among the Japanese population, existing estimates are based on the prevalence of morbidity taken from cross-sectional survey data. OBJECTIVES: This study employed a multistate life table approach to compute incidence-based health expectancy measures, namely active and inactive life expectancy (LE), for two longitudinal survey cohorts from 1990 to 2009. METHODS: This study used data from two longitudinal surveys of older adults in Japan: the National Survey of the Japanese Elderly (1990-1999) and the Nihon University Japanese Longitudinal Study of Aging (1999-2009). We employed the Interpolation of Markov Chains technique to compute the number of years at age 65 years to be spent with and without difficulty in performing activities of daily living (ADLs) or instrumental ADLs. RESULTS: We documented significant increases in active LE for men and women at age 65 years over the 10-year study period. There were significant changes in total LE for men and in the percentage of active life for women. Inactive LE did not significantly change across the two survey cohorts during the study period. CONCLUSIONS: Our results show that the health status of older adults in Japan has largely improved over the 10-year study period, with increases in both the duration of life and time spent in an active state. This finding offers evidence of compression of morbidity among older men and women in Japan.

On the measurement of healthy lifespan inequality.

BACKGROUND: Current measures to monitor population health include indicators of (i) average length-of-life (life expectancy), (ii) average length-of-life spent in good health (health expectancy), and (iii) variability in length-of-life (lifespan inequality). What is lacking is an indicator measuring the extent to which healthy lifespans are unequally distributed across individuals (the so-called 'healthy lifespan inequality' indicators). METHODS: We combine information on age-specific survival with the prevalence of functional limitation or disability in Spain (2014-2017) by sex and level of education to estimate age-at-disability onset distributions. Age-, sex- and education-specific prevalence rates of adult individuals' daily activities limitations were based on the GALI index derived from Spanish National Health Surveys held in 2014 and 2017. We measured inequality using the Gini index. RESULTS: In contemporary Spain, education differences in health expectancy are substantial and greatly exceed differences in life expectancy. The female advantage in life expectancy disappears when considering health expectancy indicators, both overall and across education groups. The highly educated exhibit lower levels of lifespan inequality, and lifespan inequality is systematically higher among men. Our new healthy lifespan inequality indicators suggest that the variability in the ages at which physical daily activity limitations start are substantially larger than the variability in the ages at which individuals die. Healthy lifespan inequality tends to decrease with increasing educational attainment, both for women and for men. The variability in ages at which physical limitations start is slightly higher for women than for men. CONCLUSIONS: The suggested indicators uncover new layers of health inequality that are not traceable with currently existing approaches. Low-educated individuals tend to not only die earlier and spend a shorter portion of their lives in good health than their highly educated counterparts, but also face greater variation in the eventual time of death and in the age at which they cease enjoying good health-a multiple burden of inequality that should be taken into consideration when evaluating the performance of public health systems and in the elaboration of realistic working-life extension plans and the design of equitable pension reforms.

Trends in happy life expectancy in Russia, 1994-2015.

Although the physical health status of the Russian population has improved over time, limited attention has been paid to the role of subjective well-being (SWB), and even less is known about its relationship with objective health conditions. Using the concept of health expectancy, this study estimates the number of years expected to be satisfied with life (happy life expectancy [LE]) for Russian men and women aged 50 years and older between 1994 and 2015. Data on age-specific prevalence rates of life satisfaction were obtained from the Russian Longitudinal Study of Higher School of Economics (RLMS-HSE), and the life tables were from the Human Life Table Database. We also tested the correlation between macroeconomic indicators and happy LE at age 50. Results based on the Sullivan method demonstrated substantial increases in happy LE at age 50 for both genders during the study period. Changes in happy LE and the percentage of happy life were significant for both genders. Furthermore, happy LE fluctuated during the 1990s but increased in the early 2000s. Importantly, the results from more recent years show stagnation and slight declines in happy LE for men and women. We also noted correlations between happy LE at age 50 and macroeconomic indicators, including gross domestic product (GDP), inflation, unemployment, and poverty rates. Taken together, the findings suggest that Russian men and women are becoming more satisfied with life as they live longer. While health has mainly been measured by mortality and morbidity in the Russian context, the finding suggests the importance of focusing more on the positive aspect of population health.

Are Religiosity and Spirituality Related to Self-Reported Health Expectancy? An Analysis of the European Values Survey.

Research on religiosity and health has generally focussed on the United States, and outcomes of health or mortality but not both. Using the European Values Survey 2008, we examined cross-sectional associations between four dimensions of religiosity/spirituality: attendance, private prayer, importance of religion, belief in God; and healthy life expectancy (HLE) based on self-reported health across 47 European countries (n = 65,303 individuals). Greater levels of private prayer, importance of religion and belief in God, at a country level, were associated with lower HLE at age 20, after adjustment for confounders, but only in women. The findings may explain HLE inequalities between European countries.

The contribution of multiple long-term conditions to widening inequalities in disability-free life expectancy over two decades: Longitudinal analysis of two cohorts using the Cognitive Function and Ageing Studies.

BACKGROUND: : Disability-free life expectancy (DFLE) inequalities by socioeconomic deprivation are widening, alongside rising prevalence of multiple long-term conditions (MLTCs). We use longitudinal data to assess whether MLTCs contribute to the widening DFLE inequalities by socioeconomic deprivation. METHODS: : The Cognitive Function and Ageing Studies (CFAS I and II) are large population-based studies of those ≥65 years, conducted in three areas in England. Baseline occurred in 1991 (CFAS I, n=7635) and 2011 (CFAS II, n=7762) with two-year follow-up. We defined disability as difficulty in activities of daily living, MLTCs as the presence of at least two of nine health conditions, and socioeconomic deprivation by area-level deprivation tertiles. DFLE and transitions between disability states and death were estimated from multistate models. FINDINGS: : For people with MLTCs, inequalities in DFLE at age 65 between the most and least affluent widened to around 2.5 years (men:2.4 years, 95% confidence interval (95%CI) 0.4-4.4; women:2.6 years, 95%CI 0.7-4.5) by 2011. Incident disability reduced for the most affluent women (Relative Risk Ratio (RRR):0.6, 95%CI 0.4-0.9), and mortality with disability reduced for least affluent men (RRR:0.6, 95%CI 0.5-0.8). MLTCs prevalence increased only for least affluent men (1991: 58.8%, 2011: 66.9%) and women (1991: 60.9%, 2011: 69.1%). However, DFLE inequalities were as large in people without MLTCs (men:2.4 years, 95%CI 0.3-4.5; women:3.1 years, 95% CI 0.8-5.4). INTERPRETATION: : Widening DFLE inequalities were not solely due to MLTCs. Reduced disability incidence with MLTCs is possible but was only achieved in the most affluent.